Pachychoroid pigment epitheliopathy in keratoconic eyes

Alessandro Feo; Riccardo Vinciguerra; Alessio Antropoli; Gianmaria Barone; Daniele Criscuolo; Paolo Vinciguerra; Vito Romano; Mario R Romano

doi:10.1007/s00417-024-06612-9

Pachychoroid pigment epitheliopathy in keratoconic eyes

Graefes Arch Clin Exp Ophthalmol. 2024 Aug 30. doi: 10.1007/s00417-024-06612-9. Online ahead of print.

Authors

Alessandro Feo¹, Riccardo Vinciguerra², Alessio Antropoli³, Gianmaria Barone⁴, Daniele Criscuolo⁴, Paolo Vinciguerra⁴, Vito Romano⁵, Mario R Romano^{4

6}

Affiliations

¹ Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy. alessandrofeo.96@gmail.com.
² Humanitas San Pio X, Milan, Italy.
³ Ophthalmology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁴ Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072, Milan, Italy.
⁵ Opththalmic Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Viale Europa 15, 25123, Brescia, Italy.
⁶ Department of Ophthalmology, Eye Unit Humanitas Gavazzeni-Castelli, Via Mazzini 11, Bergamo, Italy.

PMID: 39212800
DOI: 10.1007/s00417-024-06612-9

Abstract

Purpose: To report the association between keratoconus (KC) and pachychoroid pigment epitheliopathy (PPE). As secondary outcome, we explored the relation between subfoveal choroidal thickness (SFCT) and topometric indexes.

Methods: Retrospective, observational, cross-sectional, case-control study. Multicentric study including patients with KC and healthy controls. Each subject underwent a complete ophthalmological visit, Placido-based corneal topography, Scheimpflug corneal tomography and spectral-domain OCT (SD-OCT) with the enhanced depth imaging (EDI) mode on. Linear mixed models (LMM) were employed for comparison between groups, and to examine the impact of different topometric factors on SFCT. KC stages were defined according to Belin grading.

Results: Overall, 56 eyes from 35 KC patients and 52 eyes from 27 healthy, age- and axial length-matched control subjects were included in the study. PPE was found in 10 (17.9%) eyes from 8 KC patients, whereas was absent in all healthy controls. SFCT was statistically significantly higher in keratoconic eyes (median: 390 µm; interquartile range (IQR): 339 - 425 µm) compared to healthy eyes (median: 240 µm; IQR: 200 - 288 µm) (p < 0.001). SFCT did not differ across different KC stages and between keratoconic eyes with and without PPE.

Conclusions: PPE is a relatively frequent finding in eyes with KC, being present in about 1 out of 6 cases, regardless of disease stage.

Key messages: What is known: Keratoconus (KC) is a corneal disorder commonly associated with other chorioretinal abnormalities. It is well known that keratoconic eyes display increased choroidal thickness, and the rare association between KC and central serous chorioretinopathy (CSC) has already been reported in the literature.

What is new: We identified an association between KC and pachychoroid pigment epitheliopathy (PPE), a precursor or forme fruste of pachychoroid diseases, such as CSC. PPE presence is independent from corneal parameters and is observed in about 1 out 6 KC eyes.

Keywords: Choroid; Keratoconus; OCT; Pachychoroid; Pachychoroid pigment epitheliopathy.